Silent Siren, page 6
An elderly man sits in the dining room, slumped over his breakfast of cornflakes, his face purple, longish gray hair dipping into a bowl of milk. A middle-aged woman stands nearby, arms folded. She doesn’t look pleased to see us. In fact, she looks downright formidable.
She identifies herself as a lawyer and says the slumped man is her father. “I didn’t even want you guys,” she snaps. “My mother called. Dad doesn’t want to be brought back. He knew the CHF would kill him some day.”
A plump woman in her seventies dressed in a housecoat and worn bedroom slippers sits alone on a couch nearby, tears brimming in her eyes.
With no Do Not Resuscitate documentation, Rena and I would be well within our rights, obligated even, to yank the man from his chair and begin CPR. Given my negative experience with the ninety-two-year-old pneumonia patient, I’m not so sure that’s the right idea.
“I think we should honor his wishes,” I say, looking to Rena for approval. She has many more years of experience than me and I respect her opinion. Rena nods in assent.
Medic 21 arrives and I meet the paramedic at the door. “You guys can cancel,” I say. “This is a DOA. His family doesn’t want him resuscitated.”
The medic cocks his head to the side. “You sure?”
I nod. Heart monitor slung over one shoulder, the medic turns on his heel and walks back to Medic 21, kits in hand.
Rena and I gently lift the man’s body from the chair and place him supine on the couch so his family can say goodbye to him in a dignified manner. I pull a sheet up to his chest. The man’s wife weeps silently and holds his cold hand. Soon, police arrive and we turn the scene over to them.
I negotiate the stepping stones that meander through the weedy front yard back to the aid car. Exhaust billows from its exhaust pipe into the early morning cold. Its idling engine, low and rhythmic, is comforting.
The old man had passed away on his own terms, quickly, without suffering—as, I suspect, he would have wanted it.
As I drive back to the station, I turn to Rena and say, “I think we did the right thing,” more to assure myself than anyone else.
“I do too,” says Rena.
Stairway
Sequoia Jones and I are heading south in Rescue 21, to a reported “unknown injury accident” on Crystal Springs Drive. Calls reported as such usually amount to nothing. Often a caller has heard what he believes to be an accident or has simply driven by and seen a car in the ditch, never bothering to check and see if anyone was hurt. More than once, I have responded to a report of “unknown injury accident—heard only” to find that the “accident” was simply noisy garbage men banging cans and lids together.
Revolving red and white lights reflect off the trees as we make our way towards the scene. Aid 22 is ahead of us, probably approaching the scene if not already there. So far, there is no update. We listen to the stereo play The Bangles’ “Manic Monday” and jabber along, making small talk. It’s after midnight, and we are both anxious to get turned around and back to bed.
The radio crackles to life and interrupts our reverie. Sequoia turns down the stereo.
“Rescue 21, step it up! We have entrapment!” comes Aid 22’s frantic transmission.
Sequoia switches off the radio and guns the accelerator. Rescue 21 has the only Hurst Tool, or Jaws of Life in the department, and they need us to get a victim out of the car.
We pull up and exit the rescue truck just short of the overturned vehicle, its radiator still steaming. I grab a flashlight while Sequoia rounds the side of the rig to start the generator that will run the Hurst Tool. A firefighter in bunker gear grabs the hydraulic spreader tool and heads for the overturned vehicle that has crashed just as the pavement becomes a dirt road.
A man lies prostrate but still moving his limbs near the passenger’s side of the vehicle. EMTs Rena Clough and Lee Kimzey are in the process of backboarding him, though nobody else seems to be paying much attention to him. All attention is focused on the vehicle’s driver’s side, where a man’s T-shirted and motionless arm protrudes from underneath the wreckage. The two men are sailors from the USS Nimitz based out of Bremerton, I would later learn, out for a night of drinking on Bainbridge Island. How they ended up on the south end of the island, with no direct access to Bremerton, I will never know.
Two teenage girls stand just out of range of Rescue 21’s spotlights, timid spectators to the rescue effort. They had heard the crash and rushed out to see what all the commotion was about. Paramedic Bernie Stender stands, arms folded across his short-sleeve smock, peering into the wreckage.
Gary Clough, the fire chief and Rena’s husband, directs the rescue efforts. “Spreader, over here!” he barks.
A firefighter shoves the hydraulic spreader tip partly underneath the vehicle’s collapsed roof. The generator groans rhythmically. It’s a sound that will always stick with me, like the sound of hissing high-flow oxygen and the clanking of oxygen keys against portable aluminum tanks in a cardiac arrest—sounds that indicate Something Very Bad is unfolding.
“If he’s got a pulse, we’ll go quick. If he doesn’t, we’ll take our time,” says Gary.
He needs to get the car raised high enough so he can get his hand in and palpate for a carotid pulse. If he has none, there is no use attempting to resuscitate him. Victims of trauma who have gone into cardiac arrest rarely live and the man has been trapped under the car for some time already. In such cases, the absence of a pulse usually indicates irreparable organ damage.
Metals creaks and glass shatters as the spreader elevates the crushed hood off the pavement. The man who belongs to the arm is now partially visible. His head is turned away from us and trapped between the dash and the roof. Gary reaches in to check for a pulse. He finds none. Bernie strolls without urgency to Medic 21 and brings back with him the Lifepak 10 heart monitor/ defibrillator that will confirm death when we extricate the body.
Within a couple of minutes, the Hurst Tool in conjunction with wooden cribbing has provided an opening through which to pull the man out from underneath the vehicle without putting any firefighters at risk. Gary and Bernie slide the limp body out of the wreckage and onto the pavement, face-up. Bernie cuts his T-shirt with a pair of trauma shears.
With the exception of a deep laceration in his right shoulder from jagged metal, the man doesn’t have a mark on him. His head, however, has been crushed. It looks a little too narrow for the body to which it is attached. Clear spinal fluid streams from his ears, eyes, and nose, a sure sign that his skull is fractured in multiple places.
Bernie gels up the paddles and presses them to the man’s bare chest. Asystole—a flat line—reads out on the monitor. The girls sob.
Since nothing remains for me to do on scene, I decide to ride along to Harrison Hospital with the patient that Lee and Rena have now finished packaging. I jump into the back of Ambulance 21 just as Lee finishes placing an IV in the man’s arm. He withdraws the needle and pokes it into the bench seat. The man sings drunkenly to himself, oblivious to the events that have unfolded just outside.
Bernie opens up the ambulance doors. “Hey, dude. Your friend’s dead!” Bernie slams the doors and goes back to his own rig.
The ambulance pulls away from the scene, its drunken cargo singing off-key. The driver cranks the stereo on in the cab and hits the button for the rear speakers.
“Turn it up!” the man slurs. “I love that song!”
Led Zeppelin sings “Stairway to Heaven” as we make the long drive to Harrison.
The Blue Dog
After college, I went to work for Shepard Ambulance as an EMT. I did both 911 responses and inter-facility transfers in greater Seattle. It was a busy system and I often thought the fire departments we worked with would call us simply because they didn’t know what else to do and wanted to get a patient off their hands. Still, it was a good training ground for a new EMT. I got good at writing reports quickly, gathering the essential information I needed, and giving verbal reports to nurses at the ERs.
We actually saw some pretty critically ill people there, too. Seattle Fire Department only had six medic units for the entire city and could not always handle the volume of sick and injured patients in Seattle. At least once a week, my crew received a patient so critical we could only transport with lights and sirens and pray for the best. As EMTs, there was very little we could do for a critically ill patient besides apply direct pressure in cases of bleeding, apply high-flow oxygen, and drive like the wind.
Our ambulances were white with blue stripes, mostly of the smaller van-style, distinguishing them from Seattle Fire Department’s boxy white trucks with red stripes. It was an important distinction; private ambulance providers are the underclass of the EMS world, low-paid, long-suffering minions whose bottom line depends on fee-for-service rather than tax levies or public coffers. Seattle Fire wanted to make the distinction between our two entities as clear to the public as possible, so much so that when American Medical Response, with its white and red-striped color scheme, bought out Shepard Ambulance a year later, Seattle Fire responded by painting all its new vehicles solid red. At Shepard Ambulance, we were known as “The Blue Dog”—the German Shepherd of the ambulance world.
Ironically, when an engine company requested us on the radio, the lieutenant would ask for “one red a-m-b,” the abbreviation spelled out. In this case, the “red” referred to the speed they would like us to respond—lights and sirens—rather than our actual color. Responding “red” or “priority” was an agreement we had with Seattle Fire Department. Even for the many patients whose sickness was more mental than physical, we would put the pedal to the floor, so as to get the engine company back in service as quickly as possible. Once I responded priority for Seattle Fire, only to arrive on scene and find an old man with toenail fungus who needed a ride to his podiatrist. Another time, I spent an hour in a denture clinic, waiting for our patient to have her new chompers fashioned.
A new EMT looking for experience might stay a year or two before getting hired with a fire department or leaving the field entirely for greener, more lucrative pastures. Private ambulance was a sort of purgatory for those between the hell of having no career and the heaven of a much-coveted, well-paid, well-benefited fire career.
Though Shepard Ambulance and private ambulance service in general was well known for accepting nearly anybody with a pulse, an EMT card, and a driver’s license, a number of accomplished folks made this low-paying job their life-long career. One long-term EMT held a degree in chemistry and had been, at one time, accepted to medical school. He had been there ten years when I was hired. “The Dennys”—Denny Archer and Denny Bates, two “dinosaur” EMTs—knew every shortcut and every back road there was in the county. Though I struggled with 40 mile per hour map reading, I got through my probationary period just fine, settling into a life of urban EMS.
About a year after I went to work for Shepard Ambulance, the national ambulance conglomerate American Medical Response bought us out, as well as several smaller ambulance companies in the area. With the change came new paint jobs on the rigs, white with red stripes instead of blue, a new national administration with strict guidelines, and several unwanted accessories on the rig, including the Failsafe driving system.
The Failsafe was an annoying device mounted underneath the seat that squawked in alarm every time a driver accelerated or braked too quickly. It also activated if one took a corner too fast. High-pitched and low-pitched “counts” ticked away on a meter. High counts were the worst, and every driver was rated on the basis of counts on a sheet posted in ambulance quarters. If you were a miserable driver by Failsafe standards, it was quite humiliating. However, some drivers, frustrated with the “Big Brother” aspect of the company, deliberately racked up counts as a protest, tearing through intersections with the Failsafe squealing. One irate EMT attempted to defibrillate the Failsafe. I’m not sure how well that worked out for him.
Ambulances were assigned to posts—usually street corners in the greater King County area, based on a computer program that predicted the statistical likelihood of an emergency call within that area at a certain time of day. This was called System Status Management, and it was the bane of our existence. For the entire duration of a shift, dispatchers would request us to move from post to post. Just when we had settled on a nice, peaceful post in, say, Shoreline, we would be dispatched to do an inter-facility transfer that would put us in downtown Seattle, also known as “The Vortex.” From there, we could easily spend the entire rest of the shift bouncing from high-volume post to high-volume post. If, on a summer Saturday night, we heard “One-Zero-One to Post 21”—Fourth and Royal Brougham in downtown Seattle—we knew the rest of the shift was pretty well shot. Bring us your drunks, your smelly bums, and we shall transport them.
Dispatch kept track of us in a way that made it very difficult to hide from calls. All ambulances were equipped with satellite-based GPS, externally obvious by the “shark fins” on the ambulance box. Big Brother in his easy chair could watch us creep around like lazy ants on his computer maps, and instantly pinpoint the nearest unit to an incoming call. That pretty much put an end to the practice of failing to put oneself back in service at the hospital and sneaking down the road for a bite to eat.
Car 101, I see you!
Shit!
Just a Tune-Up
In my tenure at AMR I learned the meaning of the term “visual vitals.” Some first response crews, annoyed with or simply bored with some patients, were in the habit of fabricating vital signs that sounded plausible and even charted said vitals in the paperwork. I learned the value of performing my own, independent patient examination one day on an ambulance response to West Seattle.
Fire is on scene at a HUD housing development. My partner, Roy, and I unload our stretcher and stuff it into the too-small, urine-smelling, elevator of the dank building.
Upon entering the apartment, I am assaulted with the all-too-familiar odor of lower gastrointestinal bleeding. If you have been in EMS long enough, this is a stench you will not soon forget. It’s like a mixture of old blood and feces, and that is exactly what it is. Whether due to ulcers, cancer, a ruined liver from drinking, or a multitude of other causes, GI bleeds, as they are known, can be devastating to an already sickly patient.
The patient is about fifty, I figure, though he looks much older. He reposes silently on a bare mattress, huddled under multiple layers of clothing. The apartment is freezing. Deformed cans of Bud Light and overflowing ashtrays are strewn haphazardly on rickety furniture as well as on the filthy carpet. It’s the poster apartment for despair and poverty.
The gray-haired engine company lieutenant, reading glasses perched on the end of his nose and clipboard in hand, fills me in on the story. “This is Roger. He’s fifty-two and he’s been drinking a lot lately, just not taking care of himself, and he needs to go to the hospital for a tune-up.”
A tune-up. Apparently my patient is a car.
“What are his vitals?” I ask.
“120/60, pulse is 80.”
We prepare our stretcher, lowering it down to bed level, while the other two firefighters attempt to move our unfortunate patient off his bed. Each puts a hand under the man’s armpits and tries to persuade him to walk towards the waiting stretcher. The patient’s legs hang like limp spaghetti under his weight and he is conveyed, marionette-like, to the gurney. It isn’t so much of a walk as it is a drag.
Once in the elevator, I do a quick assessment of our hapless man. He doesn’t respond to any verbal stimuli and his eyes move around the elevator without focus. The elevator, which had smelled at first of urine, now is suffused with the smell of shit. The man’s jeans are fouled with a deep brown stain. His skin feels like ice. Reaching for his wrist, I am unable to feel a radial pulse; 120/80 my ass!
In the ambulance, I peel off layer after layer of clothing to access the man’s frail arm. How could the fire company have obtained vitals without removing clothing? I wrap the too-large blood pressure cuff around the man’s arm and watch the needle go down, down, down. Blood pressure is 60/40. So much for stable vital signs.
I do the only things I can do as a basic EMT. I place an oxygen mask on the man’s sallow face, elevate his legs to shunt the remaining blood to his vital organs, and cover him with a blanket. Then it is a rapid trip, sirens wailing, through Seattle’s streets to Harborview’s emergency room.
Taking Granny Home
Despite the occasional deathly ill patient, most of the calls we ran at AMR, and in private ambulance work in general, were routine transfers, or “grandma go home” calls, as it was sometimes known. Though necessary, they were mind-numbingly routine.
Many a time I loaded an ailing geriatric onto my gurney in the sterile, fluorescent atmosphere of a hospital medical-surgical room. The nurses, and sometimes the patient herself—if she could talk—often requested all her personal belongings be taken with us on the trip to the nursing home.
Festooned with brightly colored Mylar balloons and semi-wilted flowers in vases jammed here and there, my partner, the patient, and I would wheel slowly through the hallways, like a highly unfortunate parade float, towards the waiting elevators. Sometimes a wheelchair was necessary to move the sheer volume of belongings down to the already-cramped ambulance. Potted plants, oversized teddy bears in unnatural colors, and cards that read “Get Well Soon, Gladys” as poor Gladys languished on our cot, her tongue lolling laxly to the side. It was difficult not to wonder “Is this why I became an EMT?” We were often little more than a glorified taxi cab in which our fares rode horizontally.
The burden of transporting every patient’s belongings and sundry attachments had the potential for disaster as well. Our gurneys had X-frame wheels that folded up, allowing us to place the patient in the back of the ambulance. Often there was a sort of fabric basket just above the wheels that was convenient for carrying flowers and the like—convenient until we forgot that we had put something there. As we loaded the patient, up would go the wheels and a sickening crunch was heard as the forgotten flowers, sometimes in glass vases, would be crushed unintentionally. The worst victims of these folding-up incidents were Foley bladder bags, distended with straw-colored urine and hanging carelessly from the frames of the stretchers. Once, while placing the gurney in the ambulance, I ran the bladder bag over with one of the wheels, ripping it. Much to my chagrin, urine spilled all over the floor and into the driver’s compartment. Not a classy move.
